title: Prostate cancer screening in a healthy population cohort in eastern Nepal: an explanatory trial study.
abstract: BACKGROUND
  Prostate cancer features a substantial incidence and mortality burden, similarly to breast cancer, and it ranks among the top ten specific causes of death in males.
  
  
  OBJECTIVE
  To explore the situation of prostate cancer in a healthy population cohort in Eastern Nepal.
  
  
  METHODS
  This study was conducted in the Department of General Surgery at B. P. Koirala Institute of Health Sciences, Dharan, Nepal from July 2010 to June 2011. Males above 50 years visiting the Surgical Outpatient Department in BPKIHS were enrolled in the study and screening camps were organized in four Teaching District Hospitals of BPKIHS, all in Eastern Nepal. Digital rectal examination (DRE) was conducted by trained professionals after collecting blood for assessment of serum prostatic specific antigen (PSA). Trucut biopsies were performed for all individuals with abnormal PSA/DRE findings.
  
  
  RESULTS
  A total of 1,521 males more than 50 years of age were assessed and screened after meeting the inclusion criteria. The vast majority of individuals, 1,452 (96.2%), had PSA ≤4.0 ng/ml. Abnormal PSA (>4 ng/ml) was found in 58 (3.8%). Abnormal DRE was found in 26 (1.72%). DRE and PSA were both abnormal in 26 (1.72%) individuals. On the basis of raised PSA or abnormal DRE 58 (3.84%) individuals were subjected to digitally guided trucut biopsy. Biopsy report revealed benign prostatic hyperplasia in 47 (3.11%) and adenocarcinoma prostate in 11 (0.73%). The specificity of DRE was 66.0%with a sensitivity of 90.9% and a positive predictive value of 38.5%. The sensitivity of PSA more than 4ng/ml in detecting carcinoma prostate was 100% and the positive predictive value for serum PSA was 19.0%
  
  
  CONCLUSIONS
  The overall cancer detection rate in this study was 0.73% and those detected were locally advanced. Larger community-based studies are highly warranted specially among high-risk groups.
authors.affiliation: Department of GI Surgery, College of Medical Sciences, Nepal. narayan_299@yahoo.co.nz
authors.forename: Narayan Prasad
authors.initials: NP
authors.lastname: Belbase
authors.forename: Chandra Shekhar
authors.initials: CS
authors.lastname: Agrawal
authors.forename: Paras Kumar
authors.initials: PK
authors.lastname: Pokharel
authors.forename: Sudha
authors.initials: S
authors.lastname: Agrawal
authors.forename: Madhab
authors.initials: M
authors.lastname: Lamsal
authors.forename: Vikal Chandra
authors.initials: VC
authors.lastname: Shakya
mesh_terms: D051517:Digital Rectal Examination; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009390:Nepal; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood*; D011470:Prostatic Hyperplasia / Q000473:pathology; D011471:Prostatic Neoplasms / Q000175:diagnosis*
chemical_list: D017430:Prostate-Specific Antigen